Le leadership clinique infirmier au point de dispensation des soins est important afin d’assurer des soins de qualité et sécuritaires dans les organisations de santé (ACN, 2015 ; RNAO, 2013). Des études mettent en évidence qu’un leadership exercé par l’ensemble des professionnels de la santé, qui prennent la responsabilité individuelle et collective d’offrir des soins efficaces et de haute qualité, serait plus adapté aux réalités contemporaines des milieux de soins (West et al., 2014 ; West et al., 2015). Or, le leadership clinique des infirmières est, jusqu’à ce jour, étudié selon des rôles spécifiques, ce qui ne permet pas de comprendre comment l’ensemble des infirmières d’une unité de soins exercent leur leadership au point de dispensation des soins. Le but de l’étude était de décrire l’exercice du leadership clinique infirmier dans des unités de soins hospitaliers, les facteurs qui le favorisent et ceux qui le contraignent, ainsi que la perception qu’ont les infirmières des résultats de cet exercice du leadership pour les patients, les infirmières, l’équipe interprofessionnelle et l’organisation. Pour soutenir cette étude, l’adaptation du modèle pour le développement et le maintien du leadership proposé par l’Association des infirmières et infirmiers autorisés de l’Ontario [RNAO] (2013) a été réalisée en y intégrant les pratiques de leadership clinique énoncées par Patrick et al. (2011). Une étude de cas multiple (Stake, 1995; 2016) a été réalisée auprès de trois équipes infirmières dans un centre hospitalier universitaire québécois. L’échantillon (N = 36) se composait de 22 infirmières soignantes, de 7 assistantes infirmières-chefs, de 4 infirmières en pratique avancée et de 3 infirmières-chefs d’unité. Trente-six entrevues, 120 heures d’observation ainsi qu’une analyse documentaire ont été effectuées. Une analyse pour chaque cas (Paillé et Mucchielli, 2016) et transversale (Stake, 2016) a permis la formulation de thèmes et une modélisation de l’exercice du leadership clinique infirmier. Nos résultats indiquent que le leadership clinique infirmier se manifeste sous cinq formes actives, quel que soit le rôle de l’infirmière sur l’unité : 1) prendre des initiatives de l’ordre de la pensée réflexive et de l’intervention ; 2) influencer l’atteinte des objectifs de soins du patient/famille et le développement professionnel des collègues en leur offrant du coaching ; 3) participer et mobiliser ses collègues à contribuer à des activités d’amélioration de la qualité des soins ; 4) s’impliquer afin de promouvoir une synergie et une cohésion d’équipe optimale ; 5) mobiliser des capacités personnelles et collaboratives. Des ressources multiniveaux, une organisation du travail qui prône l’autonomie professionnelle, le leadership clinique ainsi qu’un climat de travail positif seraient favorables à l’exercice du leadership. Finalement, les infirmières perçoivent de multiples résultats positifs (ex. : diminution des complications des patients, développement professionnel des infirmières). Cette étude propose une perspective collective du leadership clinique infirmier dans des unités de soins hospitaliers, met en évidence son effet de levier pour celui-ci ainsi que pour l’atteinte de résultats positifs. Elle propose aussi une modélisation pouvant servir d’outil pragmatique. Plusieurs pistes de réflexion et d’interventions sont présentées pour la gestion, la formation, la recherche et la pratique. / Clinical nursing leadership at the point of delivery of care is important to ensure safe, quality care in health care organizations (ACN, 2015; RNAO, 2013). Recent studies show that a leadership exercised by the entire team of health professionals, taking individual and collective responsibility for providing effective and high quality care, would be more suited to the contemporary realities of care settings (West et al., 2014; West et al., 2015). However, up until now, clinical leadership of nurses has only been studied according to specific roles. This does not allow us to understand how all the nurses working in a care unit exercise their leadership at the point of delivery of care. The aim of the study is to describe the exercise of clinical nursing leadership in the context of hospital care units, the factors that favor and those that constrain it, and how nurses perceive the effects of this exercise of leadership on patients, nurses, the interprofessional team and the organization. To support this study, the conceptual model for the development and maintenance of leadership proposed by the Registered Nurses Association of Ontario [RNAO] (2013) was adapted by incorporating clinical leadership practices identified by Patrick et al. (2011). A multiple case study (Stake, 1995; 2016) was conducted with three nursing teams in a Québec university hospital center. The sample (N = 36) was composed of 22 bedside nurses, 7 assistant unit nurse managers, 4 advanced practice nurses and 3 unit nurse managers. Thirty-six interviews, 120 hours of observation and a documentary analysis were conducted. For each case, an analysis (Paillé and Mucchielli, 2016) and a cross-case analysis (Stake, 2016) permitted to formulate themes and to offer a model of the exercise of clinical nursing leadership. Our results indicate that clinical nursing leadership manifests itself in five forms, regardless of the unit nurse’s role: 1) taking initiatives involving reflective thinking and intervention; 2) influencing the achievement of patient/family care goals and the professional development of colleagues by offering coaching; 3) participating and mobilizing colleagues to contribute to activities that improve the quality of care; 4) becoming involved in order to promote optimal synergy and team cohesion; and 5) mobilizing personal and collaborative capacities. Multilevel resources, a work organization that promotes professional autonomy, clinical leadership, as well as a positive work climate were found to be favorable to the exercise of leadership. Finally, nurses perceive multiple positive results (ex. a decrease in complications for the patients and professional development for the nurses). This study suggests a collective perspective of clinical nursing leadership in hospital care units, it highlights the leverage effect for itself and the achievement of positive outcomes. It also offers a model that could serve as a pragmatic tool. Finally, various suggestions for reflection and intervention are proposed for management, training, research and practice.

Background and purpose. The purpose of the study was to determine the costs incurred on the average length of stay (ALOS) on patients with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) related illnesses admitted in hospital and whether there are any other significant costs involved. Method. A quantitative approach was used to collect data; analysed; interpretation and report writing. Purposive sampling and data collection was done using data collection sheet. This was a retrospective cost analysis data from in-patients records (record review) of ages from 15 years to 49 years both gender. Data analysis and presentation of information was presented by the use of tables; different types of graphs and the interpretation thereof. Results. The study found that males (63%) with HIV Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) related illnesses had longer average length of stay in a hospital compared to females. However, females illustrated higher in-patient costs but majority of patients had costs of between R0–R17 500. Patients with longer hospital stay (>3 days of hospitalisation) had higher in-patient costs. Conclusion. The findings also showed that in-patient care costs were directly proportional to length of stay with higher costs for HIV and AIDS patient management care. Our findings are consistent with other studies regarding higher economic implications of care for HIV infected persons being almost as twice as people who are HIV negative due to longer periods of hospitalisation. / Health Studies / M.A. (Public Health)

The aim of this study was to develop a Gestalt play therapy based hospital preparation program for children undergoing the surgical procedures of grommet insertion, or grommet insertion and adenoidectomy, at Tygerberg Hospital. Literature was reviewed according to relevant topics, namely otitis media in children, Gestalt play therapy, theories of child development, and children's experience of illness and hospitalisation. Semi-structured interviews were conducted with four subject groups and the data obtained was qualitatively analysed. Research findings were discussed and integrated with reference to the literature. This information was applied in the development of the proposed program. The aim, underlying principles, objectives and components of the program were discussed and guidelines for implementation were provided. The program was implemented and evaluated in a single subject pilot study, which yielded a positive response. Recommendations for both practical implementation in a therapeutic context and further study in a research context were made. OPSOMMING Die doel van hierdie studie was om `n Gestalt spelterapie-gebaseerde hospitaalvoorbereidingsprogram te ontwikkel vir kinders wat die chirurgiese prosedures van ventilasiebuis-plasing of ventilasiebuis-plasing en adenoïdektomie by Tygerberg-hospitaal ondergaan. `n Literatuurstudie is uitgevoer rakende relevante onderwerpe; naamlik, otitis media in kinders, Gestalt spelterapie, kinderontwikkelingsteorieë, en kinders se ervaring van siekte en hospitalisasie. Semi-gestruktureerde onderhoude is met vier subjekgroepe uitgevoer en die data wat verkry is, is kwalitatief geanaliseer. Navorsingsbevindinge is bespreek en geïntegreer met verwysing na die literatuur. Hierdie inligting is toegepas in die ontwikkeling van die voorgestelde program. Die doel, onderliggende beginsels, doelstellings en komponente van die program is bespreek en riglyne vir die implementering daarvan is verskaf. Die program is geïmplimenteer en geëvalueer in `n enkelsubjek loodsstudie, waar `n positiewe respons verkry is. Aanbevelings vir beide praktiese implementering in `n terapeutiese konteks en verdere studie binne navorsingskonteks is gemaak. / Social Work / M.Diac.

Patient and public criticism of care in many South African public hospitals has resulted in negative media reports. The purpose of the study was to determine the effect of appointing Quality Assurance Nurse Managers (QANMs) on the provision of quality patient care in selected public hospitals of the Limpopo Province and to make recommendations where appropriate. The study was quantitative, exploratory and descriptive in nature. Data was collected by means of a self-developed questionnaire from 112 respondents, consisting of 10 QANMs and 102 Quality Assurance Team members (QAT). The response rate was 100% for the QANMs and 57% for the QAT members. The study found that most of the ten selected hospitals have a good QA foundation with a vision, mission and goals, QA programme and manual. Moreover, the appointment of the QANMs had a positive impact on the nursing care. Regarding the improvement and change in the provision of nursing care, the majority of the respondents indicated that patients’ complaints about nursing care had declined considerably; the in-service training assisted in improving nursing care, and patients were nursed in totality because of the quality guidelines in the QA manuals. However, the study found that the shortage of equipment, which interferes with the delivery of quality patient care, is a serious problem that hinders the QA programme and needs to be tackled. Recommendations were made for practice and further research. / Health Studies

Thesis (MScMedSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2007. / Noise is a noxious stimulus with possible negative physiological effects on the infant, especially in the Neonatal Intensive Care Unit (NICU). The present study conducted a detailed noise assessment in a NICU of a state hospital in the Cape Metropole and documented 6 infants’ physiological responses to noise levels. Noise levels ranged from 62.3-66.7dBA (LAeq), which exceed all American and British standards (50dBA -60dBA) for a NICU. Continuous exposure to noise of these levels is potentially harmful to the infants’ auditory system and health stability. The general well-being of the staff working in the NICU may also be compromised. Analysis of the noise events revealed that staff conversations were the largest single contributor to the number of noise events, while the largest single non-human contributor was the alarm noise of the monitors. No significant correlations were found between the heart rates and noise levels and the respiratory rates and the noise levels for any of the participants in either room. The NICU was found to be an extremely reverberant environment, which suggested that the NICU noise levels were largely a result of reverberant noise reinforcements. NICU nursing staff’s most common suggestion for noise abatement strategies was reduction of staff conversation. Results of this study highlight the need for NICU noise abatement to optimise newborn patient care, reduce the risk of acoustic trauma and to improve the neonate’s quality of life, thus enhancing the infant’s physiologic stability, growth and health.

Patient and public criticism of care in many South African public hospitals has resulted in negative media reports. The purpose of the study was to determine the effect of appointing Quality Assurance Nurse Managers (QANMs) on the provision of quality patient care in selected public hospitals of the Limpopo Province and to make recommendations where appropriate. The study was quantitative, exploratory and descriptive in nature. Data was collected by means of a self-developed questionnaire from 112 respondents, consisting of 10 QANMs and 102 Quality Assurance Team members (QAT). The response rate was 100% for the QANMs and 57% for the QAT members. The study found that most of the ten selected hospitals have a good QA foundation with a vision, mission and goals, QA programme and manual. Moreover, the appointment of the QANMs had a positive impact on the nursing care. Regarding the improvement and change in the provision of nursing care, the majority of the respondents indicated that patients’ complaints about nursing care had declined considerably; the in-service training assisted in improving nursing care, and patients were nursed in totality because of the quality guidelines in the QA manuals. However, the study found that the shortage of equipment, which interferes with the delivery of quality patient care, is a serious problem that hinders the QA programme and needs to be tackled. Recommendations were made for practice and further research. / Health Studies

The aim of this study was to develop a Gestalt play therapy based hospital preparation program for children undergoing the surgical procedures of grommet insertion, or grommet insertion and adenoidectomy, at Tygerberg Hospital. Literature was reviewed according to relevant topics, namely otitis media in children, Gestalt play therapy, theories of child development, and children's experience of illness and hospitalisation. Semi-structured interviews were conducted with four subject groups and the data obtained was qualitatively analysed. Research findings were discussed and integrated with reference to the literature. This information was applied in the development of the proposed program. The aim, underlying principles, objectives and components of the program were discussed and guidelines for implementation were provided. The program was implemented and evaluated in a single subject pilot study, which yielded a positive response. Recommendations for both practical implementation in a therapeutic context and further study in a research context were made. OPSOMMING Die doel van hierdie studie was om `n Gestalt spelterapie-gebaseerde hospitaalvoorbereidingsprogram te ontwikkel vir kinders wat die chirurgiese prosedures van ventilasiebuis-plasing of ventilasiebuis-plasing en adenoïdektomie by Tygerberg-hospitaal ondergaan. `n Literatuurstudie is uitgevoer rakende relevante onderwerpe; naamlik, otitis media in kinders, Gestalt spelterapie, kinderontwikkelingsteorieë, en kinders se ervaring van siekte en hospitalisasie. Semi-gestruktureerde onderhoude is met vier subjekgroepe uitgevoer en die data wat verkry is, is kwalitatief geanaliseer. Navorsingsbevindinge is bespreek en geïntegreer met verwysing na die literatuur. Hierdie inligting is toegepas in die ontwikkeling van die voorgestelde program. Die doel, onderliggende beginsels, doelstellings en komponente van die program is bespreek en riglyne vir die implementering daarvan is verskaf. Die program is geïmplimenteer en geëvalueer in `n enkelsubjek loodsstudie, waar `n positiewe respons verkry is. Aanbevelings vir beide praktiese implementering in `n terapeutiese konteks en verdere studie binne navorsingskonteks is gemaak. / Social Work / M.Diac.

Made available in DSpace on 2011-05-04T12:36:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / perspectivas teórico-metodológicas da Gestão da Clínica e da Clínica Ampliada, identificando seus princípios, proposições, arranjos institucionais e dispositivos de gestão, além de analisar,sob o olhar dessas abordagens, duas experiências brasileiras de qualificação da assistência hospitalar. Revisão de literatura e estudo de casos compõem a metodologia da pesquisa, sendo as categorias de análise para o estudo das experiências: (1) qualidade da assistência; (2) foco no paciente; (3) adesão profissional. São discutidas a abrangência e escopo das experiências,as dimensões da qualidade nelas consideradas, além dos resultados, dificuldades e limites da implementação de mudanças. Gestão da Clinica e Clínica Ampliada buscam a melhoria da qualidade das práticas em saúde, através de atendimento individualizado, realizado por equipe multiprofissional e interdisciplinar, com um projeto terapêutico personalizado. Destacam a importância da assistência como dimensão central da gestão, colocando o paciente no foco do cuidado. Enfatizam a necessidade da participação do paciente e de seus familiares nas decisões clínicas, e preconizam mecanismos de estratificação de risco e monitoramento da qualidade assistencial. Adicionalmente, sublinham a capacitação, treinamento e valorização dos profissionais como estratégias para se obter adesão aos projetos de mudança e consideram o papel da liderança no sucesso na implementação de mudanças. Na análise de experiências conduzidas pelo Hospital São João Batista (HSJB) - Volta Redonda, RJ e Hospital Geral de Bonsucesso (HGB) Rio de Janeiro, RJ que exemplificam as duas abordagens, este trabalho discute a complexidade da implementação de mudanças na cultura organizacional no que tange à qualidade assistencial, considerando seus êxitos e fatores limitantes. Resultados observados indicam, na experiência do HSJB, aumento e qualificação da assistência, ganhos em eficiência, mudanças na cultura organizacional e no modelo de gestão do hospital, além de avanços na democratização institucional e na legitimidade do hospital junto à população. Na experiência de qualificação da assistência ao infarto agudo do miocárdio (IAM) no setor deemergência do HGB, após a implementação das estratégias facilitadoras da adesão a diretrizes clínicas, houve aumento significativo na utilização de intervenções reconhecidas como cientificamente eficazes, diminuição da iatrogenia, drástica redução da perda de oportunidadede reperfusão miocárdica, além de melhoria no preenchimento do formulário de coleta de dados. Conclui-se que, mesmo considerando a complexidade da implementação de mudanças na cultura organizacional de hospitais e o limite na incorporação de elementos teórico metodológicosem experiências concretas de qualificação da assistência hospitalar, as experiências do HGB e HSJB, embasadas na Gestão da Clínica e Clinica Ampliada, permitem a apreensão dos mecanismos de sua operacionalização, trazem contribuições para pensar a melhoria da qualidade assistencial dos hospitais públicos e endossam a perspectiva de viabilidade de um sistema de saúde mais qualificado. / This work is aimed at systematizing, based on the literature, theoretical and methodological perspectives of Clinical Governance and Extended Clinic, identifying their principles, propositions, institutional arrangements and management devices, and analyzing, under the perspective of those approaches, two Brazilian experiences on hospital care quality improvement. Literature review and cases’ study compose the research methodology, being the categories of analysis applied in the study of experiences: (1) quality of care, (2) focus on the patient, (3) professional adherence. We discuss the comprehensiveness and scope of the experiences, the dimensions of quality considered, in addition to results, difficulties and limitations of implementing changes. Clinical Governance and Extended Clinic search for quality improvement in health care practices, through individualized care, conducted by an interdisciplinary team, with a personalized therapeutic project. They emphasize the importance of health care as a central dimension of management, identifying the patient as the focus of care. They also point out the need of patients and their families’ involvement in clinical decisions, and recommend mechanisms of risk stratification and health care quality monitoring. Additionally they underline the importance of capacitating, training and awarding the professionals as strategies to achieve adherence to the project of change, and consider the role of leadership for a successful implementation of change. In the analysis of the experiences conducted by Hospital São João Batista (HSJB) - Volta Redonda, RJ – e Hospital Geral de Bonsucesso (HGB) – Rio de Janeiro, RJ, that exemplify the two approaches, this work discuss the complexity of the process of implementing changes in the organizational culture regarding care quality, accounting for successes and limiting factors. Results observed indicate, in the HSJB experience, health care increment and improvement, efficiency gains, organizational culture and management model changes, in addition to advances in institutional democratization and in hospital legitimacy in the population. In the acute myocardial infarction care quality improvement experience of HGB emergence room, after the implementation of strategies to facilitate adherence to clinical guidelines, there was significant increase in the use of interventions scientifically recognized as efficacious, reduction of iatrogenic events, drastic reduction in reperfusion loss of opportunity, besides improvement in fulfillment of the form applied in data collection. It is concluded that, even considering the complexity of implementing changes in hospitals’ organizational culture and the limited incorporation of theoretical and methodological elements in concrete experiences of hospital care improvement, the experiences of HGB and HSJB, based on Clinical Governance and Extended Clinic, allow us to capture mechanisms of their operation, bring contributions for consideration of health care quality improvement in public hospitals, and ratify the perspective that is a more qualified health care system is viable.

A lesão nasal decorrente do uso da ventilação não invasiva (VNI) é um evento adverso cada vez mais comum nas unidades de terapia intensiva neonatais (UTIN) e apresenta consequências a curto e longo prazo. Esta lesão pode resultar em sequelas tanto de ordem estética quanto funcional, limitar o uso da VNI em RN que necessita desse suporte ventilatório, causar desconforto e septicemia; podendo aumentar, desta forma, o tempo de internamento na UTIN. Esta pesquisa tem por objetivo avaliar tecnológica e clinicamente os protetores nasais empregados na VNI de RN internados na UTIN. A metodologia consistiu primeiramente em levantar as possíveis causas da lesão nasal e avaliar os fatores de risco associados ao seu desenvolvimento. Em seguida, foi realizado um ensaio clínico randomizado para comparar os efeitos de três tipos de proteção nasal e das prongas novas e esterilizadas sobre a gravidade da lesão nasal. E por fim, foi realizada a caracterização térmica e estrutural dos protetores nasais após serem envelhecidas com temperatura e umidade no interior da incubadora neonatal. As principais causas da lesão foram relacionadas às características do material, a problemas no equipamento, a fatores assistenciais, neonatais e profissionais. Neste estudo, foram constatados como fatores de risco: a idade gestacional, a massa ao nascer, o tempo total de permanência na VNI, a reutilização deste suporte, o tempo da primeira utilização e da reutilização da VNI, bem como o tempo de internação na UTIN. Não foram observadas diferenças significativas na gravidade da lesão quando comparadas as três proteções estudadas, nem quando utilizadas prongas novas e esterilizadas. Quanto à análise dos materiais, foi constatado que a exposição à temperatura e à umidade alterou a percentagem de cristalinidade e a rugosidade das proteções nasais estudadas. / The nasal injury resulting from the use of non-invasive ventilation (NIV) is an adverse event increasingly common in the newborn intensive care unit (NICU) and shows the short and long term consequences. This lesion can result both aesthetic and functional sequelae, limit the use of NIV in newborns who need this ventilatory support, cause discomfort and septicemia, may thereby increase the length of stay in NICU. This research aims to evaluate technological and clinically nasal protectors used with NIV of newborns admitted to the NICU. The methodology consisted primarily in raising the possible causes of nasal injury and assess the risk factors associated with its development. Then, it was conducted a randomized clinical trial to compare the effects of three kind of nasal protector and new and sterilized prongs on the severity of nasal lesions. And finally, it was performed the thermal and structural characterization of nasal protection after being aged with temperature and humidity inside the neonatal incubator. The main causes of injury were related to characteristics of the material, equipment problems, assistive, neonatal and professional factors. In this study, it was found as risk factors: gestational age, weight at birth, the total time stay in the NIV, the reuse of this support, the time of first use and reuse of NIV and the length of stay in the NICU. They were not observed significant differences in lesion severity when compared the three protectors studied, nor when used new and sterilized prongs. The materials analysis indicated that exposure to temperature and humidity changed the percentage of crystallinity and the roughness of the nasal protections studied.

Esta pesquisa resulta do estudo realizado com professores do Atendimento Pedagógico Domiciliar na cidade de Curitiba - PR e suas concepções quanto a utilização de jogos didáticos no ensino e aprendizagem de conceitos científicos das disciplinas de Ciências e Biologia, Física, Matemática e Química. Apresenta os conceitos de Educação Inclusiva e Especial ressaltando o conceito de Atendimento Pedagógico Hospitalar e Domiciliar. Ainda destaca a estratégia da utilização dos jogos didáticos como fator de contribuição para o desenvolvimento de habilidades cognitivas e da autoestima seriamente comprometida em função da doença do aluno atendido por esse programa da Secretaria de Educação do Estado do Paraná. Os jogos foram selecionados na internet sendo que já haviam sido testados e com resultados já registrados. A produção foi artesanal. Para o levantamento de dados foram utilizadas perguntas semiestruturadas por meio de questionário e posterior entrevista com os professores do APD. A metodologia utilizada para a análise de dados foi a de estudo de caso com enfoque qualitativo. Segundo os professores entrevistados, os jogos didáticos confirmaram ser excelente estratégia de ensino e aprendizagem enriquecendo as aulas e proporcionando aos alunos a oportunidade de aquisição do conhecimento de forma leve e divertida. / This research is the result of a study conducted with teachers Pedagogical Household Care in Curitiba - PR and conceptions about the use of educational games in teaching and learning of scientific disciplines of science and biology, physics, mathematics and chemistry concepts. Introduces the concepts of Inclusive Education and Special highlighting the concept of Hospital and Home Teaching Service. Also highlights the strategy of using educational games as a contributing factor for the development of cognitive skills and self-esteem seriously compromised because of the student served by this program the Department of Education of the State of Paraná disease. The games were selected on the internet of which had already been tested and results have already registered. The production was handmade. Semi- structured questions were used by a questionnaire and subsequent interviews with the teachers of the DPA for data collection. The methodology used for the data analysis was a case study with qualitative approach. . According to the interviewed teachers, educational games confirmed to be excellent strategy for teaching and learning enriching classes and giving students the opportunity to acquire the knowledge of light and fun way. / 5000